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General NPI Number Information
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NPI Number | 1861948853
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Entity Type | Organization
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Legal Business Name | JILL PORTER CRNP PA
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Dates
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Enumeration Date | 08/30/2016
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Last Update Date | 01/10/2023
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Provider Practice Location Address
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Address Line | 1310 BELMONT AVE SUITE 302
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City | SALISBURY
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State | MD
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Zip | 21804-4506
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Country | US
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Telephone | 410-430-7247
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Fax | 443-458-0661
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Provider Business Mailing Address
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Address Line | 1310 BELMONT AVE SUITE 302
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City | SALISBURY
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State | MD
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Zip | 21804-4506
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Country | US
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Telephone | 443-953-1278
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Fax | 443-458-0661
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Authorized Official
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Title or Position | OWNER
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Name | JILL RENEE PORTER
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Credential | CRNP
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Telephone | 410-430-7247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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